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HomeMy WebLinkAbout04-0042PETITION FOR PROBATE and GRANT OF LETTERS Estate of also known as Social Security No. ~'ZO I- / ~ .. ~.~ ~ ~ffeceased. No. o~- I - 0/4 --/l~, To: Register of V~ills for the County of Commonwealth of Pennsylvania in the The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older_an the execu - e. ~ named in the last will of the above decedent, dated Aft, ot~.$.r/~. ' ,"1 ~_~_~__ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) .D_ecendent was domiciled at death in ~ ~.~_;,]~tn~ County, Pennsylvania, with last family, or principal_residence at (list street, number and muncipality) Decendent, then q~, .years of age, died ,.7~ttl~r~ I ,1,9 ~OO~t , Except as ~llows, 'de~ede-n~ did not marry, was not divorced and did not have a child born or adopteci after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pen.n~ylvania $ situated as follows: Att~_~ WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters. theron. request(s) the probate of the last will and codicil(s) (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) Sworn to or affil~med and subscribed bef re me th~s t~ · day of L~.~.~Oc ~'~Re~[ster OATH OFPERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF (~' ~c~ A. ~s The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. No..2 Estate Of ~ ~,~ ~_ &.~o,~l,cd(~, ~q~. , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~3..xxx~.~ i~}~k(~k'94 ~i) , in consideration of the petition on 0 · the reverse side he~)eof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated il - ~ 2- Iqq ~o described therein be admitted to probate and filed of record as the last will of and Letters '-~T'~g~t~x~ (~ ~'~' are hereby granted to FEES Probate, Letters, Etc .......... Short Certificates( ) .......... TOTAL Filed . ~ z J 5 r.~.q~ .................... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Reg!strar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9825315 No. Local Registrar Date mos.;~ Rev WE';' COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH x Male , 92 -I , I : I Mar29, lgllJ Aspers, PA ~,~, ' : I ~ I,. I,. I~ i~ u ~::::~:,~ ~,~ ' ~ I~. I~ ' ~ ~ ~' I ~. ~, ~ ' I White .... Administrator 1.. Educahon ~"~'s ~L~ ~ ~..C~. Z.C~, ~C~NZ'S I,a. ,. Gettsyburg Pennsylvania 17325 " ' r- ~ ~ Adams ~ ,,~ m.~ ~.~T'S~ ~,~' CharlesEm°~R.W' Slaybauflh ~'~T~.'S ~.., ~. ~,~;:.S,.. ~ ~ c~ ~ , ~Clara' ~ ~)C°nrad :~-- Slavbaugh, Jr. J~ 331 Heritage Drive Ge~sburg, PA 17325 ~ ~'~ _ ...... ,,. I~ ~ .~,- nl I t~o ~Ol ................................. ........... " .......................................... ' ' " '~" ..... " ..... ~"~"~ D.. ~ul /g~ --.~. ep\wills \ SLAYBAGH. EP.E LAST WILL AND TESTAMENT OF CHARLES R. SLAYBAUGH, SR. I, CHARLES R. SLAYBAUGH, SR., of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. ITEM I: I direct that all my debts and funeral expenses be paid as soon as practicable after my death by my Executrix or Executor, whichever the case may be, hereinafter named. ITEM II: I give and bequeath the sum of Three Hundred ($300.00) Dollars to the Bethlehem Church Cemetery administered and managed by the Biglerville Centenary United Methodist Church, Biglerville, Pennsylvania. ITEM III: I give and bequeath the sum of Three Hundred ($300.00) Dollars to the Fairview Cemetery Association, Arendtsville, Pennsylvania. ITEM IV: All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my wife, Anna M. Slaybaugh, her heirs and assigns, provided my said wife, Anna M. Slaybaugh, shall survive me by a period of Sixty (60) days. Page 1 of 4 ITEM V: Should my said wife, Anna M. Slaybaugh, predecease me or fail to survive me by the aforesaid period of sixty (60) days, then in such event, all the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my son, Charles R. Slaybaugh, Jr., his heirs and assigns. Should my son, Charles R. Slaybaugh, Jr., predecease me, I direct the share which he would have received shall pass to his issue surviving me per stirpes and if there be no such issue then such share shall lapse. ITEM VI: I hereby nominate, constitute and appoint my said wife, Anna M. Slaybaugh, as Executrix of this my Last Will and Testament, but should she predecease me or fail to qualify, then in such event, I nominate, constitute and appoint my son, Charles R. Slaybaugh, Jr., as Executor of this my Last Will and Testament. Should my wife, Anna M. Slaybaugh, or my son, Charles R. Slaybaugh, Jr., predecease me or fail to qualify, then in such event, I nominate, constitute and appoint my grandson, Mark A. Slaybaugh, as Executor of this my Last Will and Testament. I further direct that no person serving as Executrix or Executor shall be required to post any bond to secure the faithful performance of her or his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. set my hand and seal this 1996. IN WITNESS WHEREOF, I, CHARLES R. SLAYBAUGH, SR., have hereunto -- day of , Page 2 of 4 SIGNED, SEALED, PUBLISHED and DECI~%RED by CHARLES R. SLAYBAUGH, SR., the Testator above named, as and for his Last Will and Testament, and in the presence of us, who at his request, in his presence and in the presence of each other, have subscribed our names as witnesses. Witness '~itne s s ~ Address Addre s s tained. SLAYBAUGH, SR., the Testator, this 1996. COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND : I, CHARLES R. SLAYBAUGH, SR., the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein con- CHARLES R.'S~YB~GH~ S~. / Sworn to or affirmed to and acknowledged before me by CHARLES R. /~ day of ~/ , ........ ~= '~.,~': ~., ~, 2! I, ~.~ . Notary Public ~age 3 of 4 COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND and the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. Witness Sworn to or affirmed to and acknowledged before me by witnesses, this /,~ day of ~ , 1996. Notary Public Page 4 of 4 Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: ,,~tlU~t',/ II ~OO~ WillNo. ~OtJq-O~Oql~. Admin. No. ~.1- Oq- Oa~12 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ,~pl.a~t~ ;llJ; A. aaq · Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature~~ ~ ~~.~ Address Telephone ("]t~) .~'~ ~/~/ Capacity: t,/ Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD O03636 SLAYBAUGH CHARLES R JR 331 HERITAGE DRIVE GETTYSBURG, PA 17325 ........ fold ESTATE INFORMATION: SSN: 201-16-2632 FILE NUMBER: 2104-0042 DECEDENT NAME: SLAYBAUGH CHARLES R SR DATE OF PAYMENT: 03/04/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/01/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $30,985.00 REMARKS: TOTAL AMOUNT PAID: CHARLES R SLAYBAUGH JR ~30,985.00 CHECK# 13 INITIALS: AC SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS LAST WILL AND TESTAMENT OF CHARLES R. SLAYBAUGH, SR. STONE, LAFAVER & STONE A PROFESSIONAL- CORPORATION ATTORNEYS AT LAW 414 BRIDGE STREET NEW CU~[BERLAND, PA 1T0?0 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. ,~Ot~q-OO,Oq~.. Admin. No. ~1- Oq- Oat~2 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a)~°f the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~Jtt_/,ba~'/t I~ ~0~q · Name Address /"13011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature~'~~ J~. ~~' Address Telephone ("]1~) .~_ ~l~e Capacity: s~' Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE . BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003636 SLAYBAUGH CHARLES R JR 331 HERITAGE DRIVE GETTYSBURG, PA 17325 fold ESTATE INFORMATION: SSN: 201-16-2632 FILE NUMBER: 2104- 0042 DECEDENT NAME: SLAYBAUGH CHARLES R SR DATE OF PAYMENT: 03/04/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 01/01/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $30,985.00 REMARKS: TOTAL AMOUNT PAID' CHARLES R SLAYBAUGH JR $30,985.00 CHECK//13 INITIALS: AC SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 ..H,ARRISBURG, PA 17128-0601 ~:oo 0 n o DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (~IM-DD-YEAR) J DATE OF BIRTH (MM-DD-YEAR) REV-1500 I INHERITANCE TAX RETURN 5/- RESIDENT DECEDENT i co , o.E (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY SOCIAL SECURITY NUMBER ,lol- lb THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~k-k-~ 1. Originat Return [] 2, Supplemental Return [~ 4. Limited Estate [] 4a. Future Interest Compromise (dste of death after 12-12-82) r'~ 6. Decedent Died Testate (A~ch copy of w~]l [] 7. Decedent Maintained a Living Trust (^m~ co~y of Treat) [] 9. Litigation Proceeds Received r'~ 10. Spousal Poverty Credit (date ol'dealhl)elween 12-31-91 and 1-1-95} NAa~larle$ R. ~;l--,~,ha,eL ~'r. FIRM NAME (if Applicable) I · '~' TELEPHONE NUMBER F-'~ 3. Remainder Return (date of deathl~tO 12-13-82) [~' 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~] 11. Election to tax under Sec. 9113(A) (^~ch sc~ o) COMPLETE MAILING ADDRESS '/r;- !1..3 3- o/~1 ONLY · I~[ "/o¢. oD 2. Stocks and Bonds (Schedule B) (2) 3, Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Properly (Schedule F) (6) [~ Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Proba~ Property (7) (Schedule G or L) 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expenses & Administrative Coats (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) (10) 11.' Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) (11) ..- ,.Lr;;'l~qaa (13) : ~'~'O~ ' 9.~f. 77(,, oD 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not be~n made (Schedule J} 14, Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line t4 taxable at the spousal rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate x .o (15) x .0 (1~) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19, Tax Due (19) ~;.1_. 70 ~. O~ Decedent's Complete Address: STRE.E]' ~,DDRESS Tax Payments and credits: 1. Tax Dui(Page 1 Line 19) (1)' 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount /, ~',,01. ~ , ' Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest ' E. Penalty Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. ' ; ~: (5) (5A) (5B) " Make. Check Payable to: REGISTER OF WILLS, AGENT BLOCKS PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE 1. Did decedent make a transfer and: - . ;~ -~ Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [~' b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] o. retain a reversionary interest; or .......................................................................................................................... [] E~' d. receive the promise for life of either'payments, benefit§ or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] ~' 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefidary designation? ........................................................................................................................ [] ~ IF THE ANSWER TO ANY, OF. THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying sp, hedul~ and statements, and to the best of my knowledge and belief, it is tree, correct and complete. Declaration of prepare~ other than tt~ personal representalive is based on all inforrnation~of which preParer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS . - , For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1)(i)]. For dates of death on'or after January 1, 1995, the tax rate imposed on the net value of trar~sf;~s to or for the use of the surviving spouse is 0% [72 RS. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefidary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefldaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §g116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 RS. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~ONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS All property jointly-owned with dgM of survivorship must be disclosed on Schedule F. FILE NUt',DER ITEM NUMBER DESCRIPTION $.1,o pe,,- Jo. ~o f,r ~ke~ ~o~a 15 TOTAL (Also enter on line 2, Recapitulation} VALUE AT DATE OF DEATH 5'/,,, 3~S. oo (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. Ali pmpmty Jointly.owned with the rlgM of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. pf, Jc. iYl.nefl tt14rlbt M ~'T B,,.£ cV TOTAL (Also enter on line 5, Recapitulation) :23, 32/0. do s 30 ~',,3~. oo (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)~· - .~,~, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Oh~¢l~s ii. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ,;11- Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. FUNERAL EXPENSES: I~,!~,'-~ Fu.e~,dl H~e, Inc. - 'D'~l b,)~+?-' s~r~,~.s ADMINISTRATIVE COSTS: I~S'J'4f¢ ~O{I& ~e~l~{ Personal Representative's Commissions ~Jl~a Name of Personal Representative(s) ~d,J~S Social Secu~ Num~r(s)/EIN Number of Personal Street Address City State Zip ~ Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant ~h~v'~,e:~ ~. ~!O~3~u~_j ~iP. ., StreetAddr~s ~A) ~r~ +~ ~.1~ Relationship of Claimant to Decedent ~ D~ .,oba{e Fees 9 ~a~ ~r~i ¢~ee~ Accountant's Fees Tax Return Pmpamr's Fees State _~0~, Zip ~7.~:~ TOTAL (Also enter on line 9, Recapitulation) ~ ~, qg. oo .9, ~:~e. eo 7'/5.00 (If more space is needed, insert additional sheets of the same size) RE~/-1513 EX+ (9-00~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER ! 1. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Truatee(s) .~Ot4 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES t5 THROUGH 18, AS APPROPRIATE, ON NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE AMOUNT OR SHARE OF ESTATE REV-1500 COVER SHEET B. CHARITABLE AND GOVERNMENTAL OISTRIBUTIONS TOTAL OF PART ri - ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 3 co. ~ $ I, oo. oo (If more space is needed, insert additional sheets of the aa[~-,e size) STATUS REPORT UNDER RULE 6.12 Name of Decedent: (~l~(S ~.-~[~u,k~.e~ Date of Death: ._Toa uar.- I; Will No.: Admin. No.: 'Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: o State whether administration of the estate is complete: Yes [~ No [-] If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: Did the personal representative file a final account with the Court? Yes _~ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: __ c. Did the personal r_e~resentative state au account informally to the parties in interest? Yes 1~ No' [-] Dine: ..~¥ oC. tZ Co Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Signature Nal3~e Address Telephone No. Capacity: [~'Personal Representative [~] Counsel for personal representative BUREAU OF /NDTV/DUAL TAXES INHER*rTANCE TAX DI*V/S'rON DEPT. Z80601 HARRI*SBURG, PA 171Z8-0601 CHARLES R SLAYBAUGH JR $$1 HERITAGE DR GETTYSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF /NHER/TANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCT/OHS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER .... COUNTY PA 173g~5~ RE¥-1667 EX AFP Oq-ZG-ZOOq SLAYBAUGH CHARLES Ol-O1-ZOOq Z10~-OOqZ CUMBERLAND 101 t Amoun~ Remi~ed aqT. al MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 R CUT ALONG TH'rS L'rNE ~-* RETAIN LOWER PORT'rON FOR YOUR RECORDS ~'~ ...... Charles & Lurie Sleybaugh 331 Heritage Drive Gettysburg, PA 17325 J~E~ZSTEIL oF LDZu.$ d..~mbetl~ncl Co. ~ouct Hou-~e COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003896 SLAYBAUGH CHARLES R JR 331 HERITAGE DRIVE GETTYSBURG, PA 17325 ........ fold ESTATE INFORMATION: SSN: 201-16-2632 FILE NUMBER: 2104-0042 DECEDENT NAME: SLAYBAUGH CHARLES R SR DATE OF PAYMENT: 05/03/2004 POSTMARK DATE: 05/01/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/01/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $247.21 REMARKS: TOTAL AMOUNT PAID: $247.21 SEAL CHECK# 19 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDTVZDUAL TAXES TNHERZTANCE TAX DZVTSTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 CONNONNEALTH OF PENNSYLVAN'rA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT REV-I~D7 EX AFP (01-05) CHARLES R SLAYBAUGH JR $31 HERITAGE DR GETTYSBURG PA 17325 DATE 06-01-200q ESTATE OF SLAYBAUGH DATE OF DEATH 01-01-200q FZLE NUMBER 21 Oq-OOq2 COUNTY CUMBERLAND ACN 101 Amoun~ Rem/~ed CHARLES MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~ ~:o your account, submi~c ~he upper pore/on of ~his fore wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LONER PORT*tON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~## TNHERZTANCE TAX STATENENT OF ACCOUNT ~ ESTATE OF SLAYBAUGH CHARLES R FZLE NO. 21 Oq-OOqZ ACN 101 DATE 06-01-Z004 THIS STATEMENT ZS PROVIDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHONN BELO# ZSA SUMMARY OF THE PRZNCZPAL TAX DUE., APPLZCATZON OF ALL PAYMENTS., THE CURRENT BALANCE*' AND., ZF APPLTCABLE, A PROJECTED ZNTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-26-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 32,863.00 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 1,630.79 05-01-2004 CD003636 CD003896 .00 KF PAKD AFTER THKS DATE*' SEE REVERSE SIDE FOR CALCULATKON OF ADDKTKONAL KNTEREST. ( KF TOTAL DUE KS LESS THAN $1, NO PAYMENT KS REQUKRED. KF TOTAL DUE KS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SKDE OF THKS FORM FOR KNSTRUCTKONS. ) 30,985.00 247.21 TOTAL TAX CREDZT 32,863.00 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .OO TOTAL DUE .00 PAYNENT: Detach the top portion of this Notice and submit aith your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: CONHONNEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Nills, any of the Z5 Revenue District Offices or fram the Department's Z4-hour answering service for fores ordering: 1-800-$62-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-B00-447-3020 [TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau af Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. ID0601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three [5) calendar months after the decedant's death, a five percent CBZ) discount of the tax paid is allaaed. PENALTY: The 152 tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate of .000164. Al! taxes ahich became delinquent on and after January 1, 19BI ail! bear interest at a rate which wi1! vary free calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z004 are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 ZOZ .000548 1988-1991 llZ .000301 Z001 1983 162 .000458 1992 92 .000247 ZOOZ 1984 112 .000301 1993-1994 72 .000192 2003 1985 132 .000356 1995-1998 9Z .000247 2004 1986 102 .000274 1999 72 .00019Z 1987 92 .OOOZ~? ZOOO 8Z .O00Z19 Interest Daily Rate Factor 92 .000247 62 .000164 52 .000157 42 .000110 --Interest is calcuZated as follows: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DELIN{~UENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.